HCV infection, malignancy and liver transplantation

End-stage liver disease due to hepatitis C virus (HCV) infection is one of the most common indications for liver transplantation (LT) in Western countries. Although the pathogenesis is unknown, epidemiological studies have demonstrated an association between HCV infection and the development of hepatocellular carcinoma (HCC), complications of which account for 33% of deaths among patients with HCV cirrhosis.1 HCV infection may lead not only to liver damage but also to B-cell lymphoproliferative disorders (LPDs), ranging from benign, prelymphomatous conditions, such as mixed cryoglobulinemia (MC), to frank malignancies. The possible evolution of both hepatic and extrahepatic HCV-related damage into malignant conditions makes HCV one of the most interesting oncogenic agents in humans.2 Both aspects must be taken into account in the medical approach to HCV-positive patients undergoing liver transplantation.